Supervision Interest Form

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This form is designed for individuals who have completed their graduate program or an expected to graduate within the next 6 months and are interested in applying to become a Licensed Clinical Mental Health Counselor Associate (LCMHCA) in the state of North Carolina.

This service is ideal for candidates working in a clinical, private practice setting or school setting. Please note that 1 hour of supervision is required for every 40 hours of combined direct and indirect services provided.

We look forward to supporting you on your journey toward licensure!

Full Name *

Preferred Name

Pronouns

Email for Contact *

Telephone Number *

Which of the following best describes your current post-graduate licensure status? *

I am a graduate student who is expected to graduate this year..

I have completed graduate school and plan to submit the application for LCMHCA in the near future and need a supervisor.

I have an active LCMHCA license, I work in the field of counseling part-time and I need a new supervisor.

I am a school counselor who would like to apply for the LCMHCA and need a supervisor for the hours that I will work in the school setting.

Other:

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